Lecture 8: Sedatives and Anxiolytics Flashcards
1
Q
Neurochemicals involved in sleep: sleep-promoting (4)
A
- GABA
- adenosine
- acetylcholine
- melatonin
2
Q
Neurochemicals involved in sleep: Wake-promoting (6)
A
- dopamine
- norephinephrine
- histamine
- substance P
- acetylcholine
- orexin (hypocretin)
3
Q
Sleep disorders (6)
international classification of sleep disorders 3rd edition
A
- insomnia
- sleep-related breathing disorders
- central disorders of hypersomnolence
- circadian rhythm disorders
- parasomnias
- movement disorders
4
Q
DSM5 sleep disorders (8)
A
- insomnia
- hypersolomnence d/o
- narcolepsy
- breathing-related d/o
- obstructive sleep apnea
- central sleep apnea
- sleep-related hypoventilation - circadian rhythm disorders
- Parasomnias
- NREM sleep arousal d/o
- nigthmare d/o
- REM sleep behavior disorder - restless-legs syndrome
- substance/medication-induced
5
Q
Insomnia DSM5 criteria (3)
A
- unsatisfying sleep quantity OR quality despite ample opportunity
- one or more of
a. difficulty initiating sleep
b. difficulty maintaining sleep
c. waking too early - at least 3 nights a week
- persisting for at least 3 months
6
Q
Insomnia management
non-pharmacologic) (4
A
- CBT: first line always
- multi-component therapy
- daily sleep diary
- shared decision-making
7
Q
Group sessions for insomnia (6)
A
- sleep consolidation
- relaxation scheduled “worry time”
- cognitive restructuring
- circadian rhythm entertainment
- sleep hygiene
- stimulus control
8
Q
Insomnia management: sleep hygiene (8)
A
- NO nicotine, alcohol, or caffeine
- regular exercise hours before bed
- use bed only for sleep or sex
- regular wake/sleep times
- avoid daytime naps
- avoid large amounts of liquid in evening
- comfortable environment (cool, arid, quiet, secure)
- relaxing and enjoyable activity before bed
9
Q
Safe hypnotic prescribing (4)
A
- lowest dose possible for effective dose for a limited duration
- avoid prescribing a dose greater than the maximum recommended dose
- avoid combining with CNS depressants
- use increased caution in older adults and patients with renal and/or hepatic dysfunction
10
Q
Available hypnotics (7)
A
- benzodiazepine
- non-benzo BZD-Ras
- Melatonin receptor agonist
- Orexin receptor agonist
- Antidepressants
- Antihistamiens
- OTC supplement/herb
- melatonin
- valerian
11
Q
Pt. education and monitoring (5)
A
- patients w/ cobormid depression, asses for suicidal ideation before prescribing and if present, monitor closely while considering other treatment options
- instruct patients on proper timing of the drug in relation to desired sleep onset
- instruct patients on drug half-life and expected duration of effect
- Advise against use if there is insufficient time for drug elimination between planned bedtime and rise time
- most hypnotics can be used PRN instruct patient can skip dose if already somnolent
12
Q
Patient education & monitoring Pt. II
A
- discuss rx of next day impatient in alertness, memory, coordination and driving
- discuss rx of sleep-related behaviors such as sleep walking, eating, and driving
- many rxed hyponitcs are controlled substances
- schedule regular f/u to review efficacy, SE, non-pharmacologic options, asses ongoing need for rc
- rebound insomnia may occur is used for extended period of time
13
Q
NOT recommended for insomnia (2)
A
- gabapentin
- atypical antipsychotics
- quetiapine, olanzapine
14
Q
Highlights guidelines recommendations for treatment of insomnia (4)
A
- CBT-1 as first-line
- short acting BZDS or Z-drugs for up to 4 weeks
- Ramelteon or Suvorexant
- Doxepin 1-6 mg
15
Q
Neurobiology of Anxiety (3)
Part of brain?
Regulators (5)
A
- amygdala of limbic sytem
a. processing memory
b. emotional reactions: flight/fight - regulated by
a. norepinephrine (NE)
b. serotonin (5-HT)
c. corticotropin- releasing hormone system
- supresion of hypothalamic-pituitary-adrenal axis
d. y-aminobutyric acid (GABA)
e. glutamine
